Provider Demographics
NPI:1134583933
Name:CHIROPRACTIC HEALTH CENTERS
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-271-3160
Mailing Address - Street 1:17228 LANCASTER HWY
Mailing Address - Street 2:UNIT 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2078
Mailing Address - Country:US
Mailing Address - Phone:704-271-3160
Mailing Address - Fax:704-675-5524
Practice Address - Street 1:17228 LANCASTER HWY
Practice Address - Street 2:UNIT 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2078
Practice Address - Country:US
Practice Address - Phone:704-271-3160
Practice Address - Fax:704-675-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCQ077AMedicare PIN